Coping skills training for arthritis: An effectiveness trial

关节炎应对技能训练：有效性试验

基本信息

批准号：
7932450
负责人：
Joan E Broderick
金额：
$ 16.8万
依托单位：
STATE UNIVERSITY NEW YORK STONY BROOK
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-09-22 至 2012-09-21
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7932450
关键词：
Adherence Adopted Adoption Adult Adult Health Nursing Affect Aftercare Age-Years Arthritis Behavior Therapy Behavioral Behavioral Medicine Caring Centers for Disease Control and Prevention (U.S.)Characteristics Chronic Cities Clinical Communities Community Practice Complex Computers Consumer Satisfaction Control Groups Coping Skills Counseling Cultural Diversity Data Degenerative polyarthritis Diagnosis Discipline of Nursing Disease Progression Dose Educational Intervention Educational process of instructing Effectiveness Evaluation Foundations Goals Guidelines Health Personnel Health Policy Healthcare Healthy People 2010 Impairment Intervention Laboratories Living Wills Maintenance Measures Medical Medicine Mental Health Modeling Nurse Practitioners Nurses Office Nursing Outcome Assessment Outcome Measure Pain Pain Measurement Patient Care Patient Education Patient Self-Report Patients Persons Pharmaceutical Preparations Physicians Policy Maker Primary Care Physician Primary Health Care Protocols documentation Provider Psychologist Public Health Quality of life Randomized Reapplication Relative (related person)Research Research Personnel Sampling Science Self Efficacy Site Social Functioning Staging Target Populations Techniques Telephone Testing Therapeutic Time Training Translating Translational Research Treatment Protocols Treatment outcome United States National Institutes of Health arthritis education base chronic pain cognitive behavior therapy coping cost effectiveness design disability effectiveness research effectiveness trial efficacy trial follow-up functional disability health care delivery health economics health related quality of life improved improved functioning innovation model design multi-site trial patient population programs psychologic psychological distress psychosocial research to practice satisfaction skills skills training statistics suburb theories therapy design treatment as usual treatment effect trial comparing uptake

项目摘要

DESCRIPTION (provided by applicant): The leading cause of disability in the U.S. is arthritis, affecting approximately 60 percent of those over 65 years of age. Biomedical treatments are limited in their ability to curb osteoarthritis (OA) disease progression and to eliminate pain and functional impairment. Health-related quality of life measures consistently document significant impairment in persons with arthritis. Efficacy trials have documented that Pain Coping Skills Training (CST) for arthritis reduces pain, improves physical and social functioning, increases self-efficacy, and reduces psychological distress. Despite this, CST is unavailable to the vast majority of OA patients. Increasing patient access to CST will require an innovative healthcare model. Ideally, CST should be integrated into patients' community medical settings. Among providers in these settings, nurse practitioners (NP) with their training in patient education, seem well-suited to deliver CST. This application is the first effectiveness trial -bringing CST from academic settings into community primary care offices where NPs will be trained to deliver manualized, 10-session CST. A randomized, controlled (treatment vs. usual care) multi- site trial (N=272) for OA patients with chronic pain is proposed. Intent-to-treat analyses will evaluate whether this treatment delivery model yields significant benefits compared with a usual-care control group. Assessments of pain, physical and psychological disability, self-efficacy, pain coping skills, and quality of life will be conducted pre-treatment, post-treatment, and at 6-month, 1-, 2-year follow-ups. Cost-effectiveness analyses will be conducted. This study will make important contributions to the science of effectiveness research through comprehensive assessment of outcomes specific to effectiveness research. Analyses will examine reach into the target population, assessment of treatment fidelity by NPs, patient uptake of treatment, consumer satisfaction, and utilization of medication and other arthritis treatments. If this trial is successful, it will set the stage for subsequent studies to investigate innovative strategies to enhance maintenance of CST effects, to incorporate telephone and computer delivery of CST, and to conduct health economic analyses. This research will test an innovative health care delivery model designed to make pain coping skills training (CST) more widely available to patients with arthritis. CST has been shown to improve patients' functioning and quality of life beyond what medications and other medical treatment offer. This R01 reapplication proposes to examine the effectiveness of having nurse practitioners in primary care practices deliver a psychological intervention--Pain Coping Skill Training (CST) -- to osteoarthritis patients. Patients' pain, psychological disability, self-efficacy, pain coping skills, and quality of life as well as cost effectiveness will be measured.

描述（由申请人提供）：在美国，导致残疾的主要原因是关节炎，约 60% 的 65 岁以上老年人受到影响。生物医学治疗在抑制骨关节炎 (OA) 疾病进展以及消除疼痛和功能障碍方面的能力有限。与健康相关的生活质量测量始终记录关节炎患者的显着损害。功效试验表明，针对关节炎的疼痛应对技能训练 (CST) 可减轻疼痛、改善身体和社会功能、提高自我效能并减少心理困扰。尽管如此，绝大多数 OA 患者无法进行 CST。增加患者获得 CST 的机会需要创新的医疗模式。理想情况下，CST 应融入患者的社区医疗环境。在这些环境中的提供者中，接受过患者教育培训的执业护士 (NP) 似乎非常适合提供 CST。该应用程序是第一个有效性试验 - 将 CST 从学术环境引入社区初级保健办公室，在那里 NP 将接受培训以提供手动的 10 次 CST。建议对患有慢性疼痛的 OA 患者进行一项随机对照（治疗与常规护理）多中心试验 (N=272)。意向治疗分析将评估这种治疗提供模式与常规护理对照组相比是否产生显着益处。将在治疗前、治疗后以及 6 个月、1 年、2 年随访时对疼痛、身体和心理残疾、自我效能、疼痛应对技能和生活质量进行评估。将进行成本效益分析。这项研究将通过对有效性研究的具体结果进行综合评估，为有效性研究科学做出重要贡献。分析将检查目标人群的覆盖范围、NP 治疗保真度的评估、患者对治疗的接受情况、消费者满意度以及药物和其他关节炎治疗的利用。如果这项试验成功，将为后续研究奠定基础，以调查增强 CST 效果维持的创新策略、纳入 CST 的电话和计算机交付以及进行健康经济分析。这项研究将测试一种创新的医疗保健提供模式，该模式旨在使关节炎患者更广泛地获得疼痛应对技能培训（CST）。 CST 已被证明可以改善患者的功能和生活质量，其效果超出了药物和其他医疗方法。此次 R01 重新申请旨在检查初级保健实践中的执业护士向骨关节炎患者提供心理干预——疼痛应对技能培训 (CST) 的有效性。将测量患者的疼痛、心理残疾、自我效能、疼痛应对技能、生活质量以及成本效益。